Factitious disorders are conditions in which a person acts as if he or she
has a physical or mental illness when he or she is not really sick. Factitious
disorder by proxy is when a person acts as if a person in their care has an
illness when they do not.

People with factitious disorders deliberately create or exaggerate symptoms
of an illness in several ways. They may lie about or fake symptoms, hurt
themselves to bring on symptoms, or alter tests (such as contaminating a urine
sample) to make it look like they or the person in their care are sick.

People with factitious disorders behave this way because of an inner need to
be seen as ill or injured, not to achieve a clear benefit, such as financial
gain. People with factitious disorders are even willing and sometimes eager to
undergo painful or risky tests and operations in order to obtain the sympathy
and special attention given to people who are truly ill or have a loved one who
is ill. Factitious disorders are considered mental illnesses because they are
associated with severe emotional difficulties.

Many people with factitious disorders also suffer from other mental
conditions, particularly personality disorders. People with personality
disorders have long-standing patterns of thinking and acting that differ from
what society considers usual or normal. These people generally also have poor
coping skills and problems forming healthy relationships.

Factitious disorders are similar to another group of mental disorders called
somatoform disorders, which also involve the presence of symptoms that are not
due to actual physical or mental illnesses. The main difference between the two
groups of disorders is that people with somatoform disorders do not fake
symptoms or mislead others about their symptoms on purpose.

Types of Factitious Disorders

There are four main types of factitious disorders, including:

Factitious disorder with mostly psychological symptoms: As the
description implies, people with this disorder mimic behavior that is
typical of a mental illness, such as schizophrenia. They may appear
confused, make absurd statements and report hallucinations, the experience
of sensing things that are not there; for example, hearing voices. Ganser
syndrome, sometimes called prison psychosis, is a factitious disorder that
was first observed in prisoners. People with Ganser syndrome have short-term
episodes of bizarre behavior similar to that shown by people with serious
mental illnesses.

Factitious disorder with mostly physical symptoms: People with
this disorder claim to have symptoms related to a physical illness, such as
symptoms of chest pain, stomach problems, or fever. This disorder is
sometimes referred to as Munchausen syndrome, named for Baron von
Munchausen, an 18th century German officer who was known for embellishing
the stories of his life and experiences.

Factitious disorder with both psychological and physical symptoms:
People with this disorder produce symptoms of both physical and mental
illness.

Factitious disorder not otherwise specified: This type includes a
disorder called factitious disorder by proxy (also called
Munchausen
syndrome by proxy). People with this disorder produce or fabricate symptoms
of illness in another person under their care. It most often occurs in
mothers (although it can occur in fathers) who intentionally harm their
children in order to receive attention.

Appearance of new or additional symptoms following negative test
results

Presence of symptoms only when the patient is with others or being
observed

Willingness or eagerness to have medical tests, operations, or other
procedures

History of seeking treatment at many hospitals, clinics, and doctors
offices, possibly even in different cities

Reluctance by the patient to allow health care professionals to meet
with or talk to family members, friends, and prior doctors

What Causes Factitious Disorders?

The exact cause of factitious disorders is not known, but researchers are
looking at the roles of biological and psychological factors in the development
of these disorders. Some theories suggest that a history of abuse or neglect as
a child, or a history of frequent illnesses that required hospitalization might
be factors in the development of the disorder.

How Common Are Factitious Disorders?

There are no reliable statistics regarding the number of people in
the U.S. who suffer from factitious disorders. Obtaining accurate
statistics is difficult because dishonesty is common with this
condition. In addition, people with factitious disorders tend to seek
treatment at many different health care facilities, which can lead to
statistics that are misleading.

In general, factitious disorders are more common in men than in
women. However, factitious disorder by proxy tends to be more common in
women than in men.

How Are Factitious Disorders Diagnosed?

Diagnosing factitious disorders is very difficult because of, again,
the dishonesty that is involved. Doctors must rule out other possible
physical and mental illnesses before a diagnosis of factitious disorder
can be considered.

If the doctor finds no physical reason for the symptoms, he or she
may refer the person to a psychiatrist or psychologist, mental health
professionals who are specially trained to diagnose and treat mental
illnesses. Psychiatrists and psychologists use specially designed
interview and assessment tools to evaluate a person for a factitious
disorder. The doctor bases his or her diagnosis on the exclusion of
actual physical or mental illness, and his or her observation of the
person's attitude and behavior.

How Are Factitious Disorders Treated?

The first goal of treatment for a factitious disorder is to modify the
person's behavior and reduce his or her misuse or overuse of medical resources.
In the case of factitious disorder by proxy, the main goal is to ensure the
safety and protection of any real or potential victims. Once the initial goal is
met, treatment aims to work out any underlying psychological issues that may be
causing the person's behavior.

The primary treatment for factitious disorders is psychotherapy (a
type of counseling). Treatment likely will focus on changing the
thinking and behavior of the individual with the disorder
(cognitive-behavioral therapy). Family therapy may also be helpful in
teaching family members not to reward or reinforce the behavior of the
person with the disorder.

There are no medications to treat factitious disorders themselves.
Medication may be used, however, to treat any related disorder -- such
as depression, anxiety, or a personality disorder. The use of
medications must be carefully monitored in people with factitious
disorders due to the risk that the drugs may be used in a harmful way.

What Is the Outlook for People with Factitious Disorders?

People with factitious disorders are at risk for health problems (or
even death) associated with hurting themselves or otherwise causing
symptoms. In addition, they may suffer from reactions or health problems
related to multiple tests, procedures, and treatments; and are at high
risk for substance abuse and attempts at suicide. A complication of
factitious disorder by proxy is the abuse and potential death of the
victims.

Because many people with factitious disorders deny they are faking
symptoms and will not seek or follow treatment, recovery is dependent on
a doctor or loved one identifying or suspecting the condition in the
person and encouraging them to receive proper medical care for their
disorder and stick with it.

Some people with factitious disorders suffer one or two brief
episodes of symptoms and then get better. In most cases, however, the
factitious disorder is a chronic, or long-term, condition that can be
very difficult to treat.